John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

>>> “I think we’re going to see a tremendous increase in EMR purchases at that point in time.”

Why did you believe this back then, John?

Doctors aren’t stupid- most won’t throw themselves at MU’s $44,000.00 only to be left straddled with a loss from year 1 due to the estimated costs of owning an EHR and doing MU for eternity of $40-60,000.00 per year.

Time has shown that the HIT industry has stagnated, with few doctors now buying into the politically driven HITECH Act. I can’t wait until the next CDC biyearly report…

Here’s my response to Al’s comment:

Al,
I still think that statement’s true. There’s going to be a spike in those that purchase EMR software to get the EMR stimulus money. Many were already considering buying it before the stimulus and now a good number of doctors will buy an EMR now that we have the details and timelines for the EMR stimulus.

After this jump in sales, it’s then going to be interesting to watch. The future sales of EMR software are going to be highly dependent on the experience of these initial EMR implementations. If they’re successful and doctors like their EMR and get the EMR stimulus money, then we’ll see more EMR adoption. If they don’t like it or have trouble getting the EMR stimulus money or experience many of the headaches of EMR adoption that we’ve seen before, then I believe it will actually set EMR adoption back long term.

I know which way you lean on that scale. I still think the jury is out, but I am concerned that the later scenario is a distinct possibility.

If the later scenario of an EMR adoption setback occurs, I’m not sure we’ll come out of it until the next generation of “digital natives” finish medical school and achieve prominent enough status in a clinic to push EMR adoption again.

I did misjudge the time it would take to really get the details of the EMR stimulus in place. I thought by February or March of 2010 we’d have known more than we did. Turns out the legislative details took much longer than I expected, but I think we’ll see the EMR adoption spike now that the details are finally in. At least that’s the view I see as far as action and interest in selecting and implementing an EMR.

What do you guys think? How is EMR adoption going and what EMR adoption trends do you see happening in the future?

16 responses to "EMR Adoption Trends"

I don’t really believe that EHR adoption will be driven by digital natives, unless digital natives don’t mind being poor. EHR adoption, like most things in this world, are driven by economics. If value exceeds cost, then there will be net adoption and if cost exceeds value, there will be slower EHR adoption (duh!).

I recently wrote an article for the Canadian EMR marketplace (in Canada they call the EHR an EMR) on the economics of EMRs. It’s no different in the US.

The main finding was that if there is good integration of data from other organizations (hospital, specialists, lab, diagnostic imaging), then the maintenance costs of running the system will be lower –mainly because you don’t have to hire somebody to scan and index a paper document that was initially generated electronically. If there is poor integration, the net costs to participating physicians will be high and adoption will be poor.

Hi John
From the perspective of a small, passionate EHR Vendor who has been certified by ONC-ATCB for complete EHR, we see the demand spike up. Our sales volume has grown considerably and we are holding back to make sure that our support resources are aligned with sales. So, from close quarters, we can see the demand spike up.
Secondly, although the incentives are discussed during the sales cycle, it is a secondary or tertiary factor in decision making. From my interactions with the Physicians on a daily basis, incentives are a factor, but no the driving force.
EHR by itself is not also the main driving force; but the ability to manage the operations more efficiently, I would say, is one of the main driving forces. e-g., the bi-directional data flow with the labs and the ability to receive structured data which then gets auto-populated within the patient records, by itself is a huge time and resource saver. One of our Pediatricians estimates that he saves upto half FTE, who otherwise would have received 30 to 40 faxes of multiple pages and then would have sorted them out, prior to presenting it to Physician and then filing them away. I can go on and on about various cost savings achieved by the practices including the ability to fax from within the system resulting in substantial savings of personnel time and paper. These are simple cost savings achieved through effective use of IT and not related to EHR and its benefits. The same personnel who were doing these administrative tasks are now available to reach out to patients w/ reminders, call backs, preventive care, etc., resulting in increased revenues.
And finally, costs do play an important role; but with good systems being offered as SaaS currently and at a reasonable fee of $500+ or so per month with implementation charges of less than $5000 – it is easily comparable to the cost savings, leave alone the incentive monies. Anywhich way, the practices were/are paying the yearly maintenance of $1000 if not more for the current PMS systems that they have.
All in all, the hype or the lack thereof, about the costs of EHR being too high has been blown out of proportion; I keep myslef informed about various things in the market place through blogs such as yours; at the same time, would like to point out to this hype about costs being too high which is not really true. Being in the trenches, we do see that the costs are comparable or even much less than than the cost savings achieved by practices.

Anthony,
It’s amazing to think back to 3-4 years ago and the price of an EMR. The prices have definitely come down to a more reasonable number to manage. I feel bad for those who purchased the 6 figure EMR software. That’s a much harder ROI case to build.

I still say use a free system, like we’re using Practice Fusion, and all of these issues become nonissues. I don’t understand why anyone would choose to pay for something that they can receive for free.

Dr. West, free is a relative/subjective term; yes, you will have to give up the comfort and are forced to see the advertisements, whether its relevant or not. There is a cost associated with that and a cost associated with the vendor having the right to sell the de-sensitized data.
And finally, there is also a substantial cost associated with integrating the EHR with a Billing System, manually or otherwise.

Anthony, I’ve actually become more comfortable after implementing my free EMR, not less. The cost of selling de-sensitized data is nothing to me, and it’s not an illegal or unethical process. And the costs of my billing system integration with the EMR, I never see because we are not using this integration.

Dr. West, I understand your views and respect that. All I wanted to really bring to front and all to understand is there is a cost – whether its real $$ cost or perceived cost associated with other subjective adjustments and compromises.
Its similar to using the gmail for business; as you may be aware of, businesses, whatever size they are, sue their own domain and email severs to communicate and prefer not to have the @gmail, @aol, etc. Most of the businesses are dealing with sensitive data and would prefer to respect their communications and do not want those to be viewed by a google or an AOL. Plus an email ID with the domain name of the business adds that much of credibility to the business.
I do use gmaeil for personal use and try and ignore the advertisements. It does bother me at times.
I am glad it has worked out for you. And it validates the fact that one shoe does not fit all.
On the cost of integrating the billing platform, although you don’t see the cost, nevertheless there is a cost. Either billing outourcer or your inside biller print the superbill and then do the entry in the billing system or some such thing that does increase the work further and there is a cost involved. I understand you don’t see it; does not mean the cost is not factored in the transaction.

Good luck Dr. West; I respect the fact that you have implemented EHR (free or otherwise) and you are defenitely an early adapter. Hopefuly over the next 3 years a majority of the professionals would have implemented EHR

Hi John; just to give a feedback on EHR purchase and adoption, it has really spiked and we do see the difference. It has been extremely busy period and we believe its going to be this way for the next 12 months based on the pipeline we have.
More and more are undestanding the value behind it and the noise created by ONC and Incentives is defenitely a catalyst for the providers to peak through the covers; once they see a demo, the do appreciate the benefits such solutions bring. Yes the ‘fear of change’ is there; but is overcome by the industry moving forward and they do not want to be left behind.

Karim, Of course, your comments assume that adopting an EMR makes a doctor poor. I know a lot of doctors who use EMR quite successfully with a great return on their investment. Plus, the digital native doctors that I’ve talked to can’t imagine the idea of using paper. They don’t understand why doctors still do. That perspective will change things even if cost is an issue.

I’m not saying EHR makes doctors poorer. I am saying that as long as the economics force doctors to spend more than they make (which applies to the vast majority of doctors in the US and Canada who don’t work in a large clinic or who don’t work in an HMO), then adoption will be slow.

There are a lot of benefits to EHR, but if you don’t have electronic feeds from hospital, specialists and diagnostic imaging, then you’re going to have to convert paper to electronic form. That is a costly endeavor.

For physicians who work in large clinics or who work for an HMO, that cost is already absorbed as part of doing business. But that applies only to about 25-30% of physicians who work in the US and only about 15-20% of physicians in Canada.

Karim,
Certainly interfaces with those various organizations is ideal and can save a lot of time and money. However, even in the paper world there is cost associated with the communications from these organizations (ie. printing the faxes and filing them in the chart, not to mention routing charts for signing, etc). Much of this information comes in from these organizations through your fax machine. A nice eFax integration with your EMR or even a simple fax server makes adding these communications into your EMR much easier than in the paper world. Plus, you don’t have the expense of printing them all out.